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Owing to high price of artemisinin combination therapy (ACT), the most effective medicines for treating malaria, ineffective monotherapies are dominating high-burden malarious countries.

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Dr. Kathryn O'Connell said that majority of malaria endemic countries changed malaria treatment policies more than three years ago in the face of widespread drug resistance to monotherapies, adopting extremely effective artemisinin combination therapy, however, years later, the availability of these more effective medicines has been shown to be as low as 20pct in public sector health facilities.

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Even in the private sector, where the majority of patients seek treatment, availability is still relatively low compared to cheaper, but less effective, drugs.

"These data confirm that access to ACTs is restricted by their high price. A full course of an adult treatment of ACT can be up to 65 times the minimum daily wage. This provides an overpowering incentive for a consumer to make the wrong antimalarial choice," said Dr. Desmond Chavasse, Vice President of Malaria Control and Child Survival at PSI.

In most countries, ACTs currently make up only 50pct of the total volume of antimalarials on the market, with ineffective monotherapies dominating the market share.

More disturbing still, despite a call by the World Health Organization to ban artemisinin monotherapies, these continue to permeate private sector markets in key countries such as Nigeria and the Democratic Republic of Congo, which together account for 30pct of the total malaria-related disease burden in sub-Saharan Africa.

In the Nigerian context this is particularly important as approximately 95percent of all antimalarials are delivered through the private sector.

With most people accessing antimalarial medication through the private sector, price becomes a critically important barrier affecting demand and utilization of the more expensive but also most effective treatments.

Artemisinin combination therapies can be over twenty times more expensive than ineffective therapies such as chloroquine.

"The operation of the distribution chain has a major influence on which antimalarials are available to retailers, and their price and quality," said Dr. Kara Hanson of the London School of Hygiene and Tropical Medicine.

"Influencing practices of providers near the top of the chain may be the most cost-effective way to change outcomes in this market," said Hanson.

The findings were presented at 5th Multilateral Initiative on Malaria (MIM) Pan-African Malaria Conference in Nairobi.

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